不同小剂量多巴酚丁胺超声心动图试验识别急性心肌梗死存活心肌的对比研究

Comparison of different low dose dobutamine echocardiography for identifying viable myocardium in patients with acute myocardial infarction

目的 评价不同小剂量 [3,5 ,和 1 0 μg/ (kg·min) ]多巴酚丁胺二维超声心动图 (Dob 2DE)试验识别急性心肌梗死 (AMI)患者存活心肌的准确性和安全性 ,探讨Dob最小有效剂量。方法 AMI患者 31例 ,均于梗死后 7～ 1 4d行不同小剂量Dob 2DE试验 ,并成功接受了冠状动脉血运重建术 (CRV) ,术后约 6个月复查 2DE。将试验时检出存活心肌节段与CRV术后相应节段收缩改善的实际对比 ,计算识别存活心肌的准确性 ,评价其安全性。结果 31例AMI患者的 2 2 1个室壁运动异常节段中 ,三种剂量Dob[3,5 ,和 1 0 μg/(kg·min) ]2DE试验分别检出 40 .7%、5 0 .2 %和 5 5 .8%的存活心肌节段 ;识别存活心肌的敏感性分别为6 1 .6 %、78.4%和 89.4% ,阴性预测值及准确性分别为 6 3.4%、75 .5 %和 87.9%及 72 .4%、81 .9%和 86 .8% ,Dob 3μg/ (kg·min)时各值均显著降低 (P均 <0 .0 5 ,0 .0 0 1 ) ,而Dob 5和 1 0 μg间除敏感性外均无显著差异。Dob 3,5和 1 0 μg/ (kg·min)副作用发生率分别为 0、1 2 .9%和 2 9.0 % ,特别是Dob 1 0 μg/ (kg·min)时诱发心肌缺血 2例 (6 .9% )。结论 Dob 1 0 μg/ (kg·min) 2DE试验识别AMI存活心肌最准确 ,但欠安全 ;Dob 3μg/(kg·min) 最安全 ,但敏感性下降 ;Dob 5 μg/ (kg·min)

Objective To evaluate the accuracy and safety of different low dose [3,5 and 10 μg/(kg·min)] dobutamine (Dob) two dimensional echocardiography (2DE) for detecting viable myocardium, and to seek an optimal dose of Dob for chinese patients with acute myocardial infarction(AMI).Methods In 31 patients with AMI who were scheduled to undergo coronary revascularization (CRV), low dose [3,5 and 10 μg/(kg·min)] Dob 2DE tests were conducted 1～2 weeks [(10±3) days] after the infarction. CRV was successful in all patients, and the follow up 2DE were also done about 5～6 months after CRV. The detected viable myocardium after the tests were compared with the post CRV actual contractile improvement of corresponding segments to calculate the sensitivity, specificity, positive and negative predictive value (PPV and NPV) and accuracy of the tests for identifying viable myocardium.The safety of these tests were also evaluated.Results Among 221 abnormal segments in 31 patients with AMI, the rates of viable myocardial segments detected by Dob 3,5 and 10 μg/(kg·min) 2DE tests were 40.7% , 50.2% and 55.8% , respectively, which in Dob 5 and 10 μg/(kg·min) were significantly higher than that in Dob 3 μg/(kg·min) (both P< 0.05 ). The sensitivity of low dose [3,5 and 10 μg/(kg·min)] Dob 2DE tests for the identifying viable myocardium were 61.6% , 78.4% and 89.5% , respectively. There were significant differences between each two dosage (P< 0.01 , 0.001 ). The NPV were 63.4% , 75.5% and 86.8% , and accuracy 72.4% , 81.9% and 87.9% , respectively, with those in Dob 5 and 10 μg/(kg·min) being significantly higher than those in Dob 3 μg/(kg·min) (P< 0.01 , 0.001 ). On the other hand, the rates of side effects in 3, 5 and 10 μg were 0 , 12.9% and 29.0% , respectively. Myocardial ischemia had been induced by Dob 10 μg/(kg·min) in 2 cases ( 6.9% ).Conclusions For identifying viable myocardium with different low dose [3,5 and 10 μg/ (kg·min) ] Dob 2DE test in patients with AMI, Dob 10 μg/(kg·min) is the most accurate though less safe, Dob 3 μg/ (kg·min) is safest but less sensitive, and Dob 5 μg/(kg·min) may be an optimal dose for Chinese,which is more sensitive and accurate than Dob 3 μg/(kg·min) and safer than Dob 10 μg/(kg·min).